I 

116TH CONGRESS 

1ST SESSION H. R. 2922 

To address the opioid epidemic, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 22, 2019 

Ms. KUSTER of New Hampshire (for herself, Mr. FITZPATRICK, Ms. SCANLON, Ms. PINGREE, Ms. STEVENS, Ms. JACKSON LEE, Ms. FRANKEL, 

Mr. TRONE, Mr. TONKO, Mr. RASKIN, Ms. BROWNLEY of California, Mr. 

DOGGETT, Mr. PAPPAS, Ms. CLARK of Massachusetts, Mrs. TRAHAN, Mr. 

WELCH, Mr. CASTRO of Texas, Mrs. DINGELL, Ms. SHALALA, Ms. 

MOORE, Mr. MCNERNEY, Mr. MOULTON, Ms. BLUNT ROCHESTER, Mr. 

MCGOVERN, Mr. LARSON of Connecticut, Mr. CROW, Ms. MATSUI, Ms. 

KELLY of Illinois, Ms. BARRAGA ́N, Ms. SCHAKOWSKY, Mr. VEASEY, and 

Ms. BASS) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

the Judiciary, Ways and Means, the Budget, and Education and Labor, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

A BILL 

To address the opioid epidemic, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Respond to the Needs 

5 in the Opioid War Act’’ or the ‘‘Respond NOW Act’’. 


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1 SEC. 2. TABLE OF CONTENTS. 

2 The table of contents of this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—OPIOID EPIDEMIC RESPONSE FUND 

Sec. 101. Opioid Epidemic Response Fund. 

Sec. 102. Substance Abuse and Mental Health Services Administration. 

Sec. 103. Centers for Disease Control and Prevention. 

Sec. 104. Food and Drug Administration. 

Sec. 105. National Institutes of Health. 

Sec. 106. Health Resources and Services Administration. 

Sec. 107. Administration for Children and Families. 

TITLE II—ADDITIONAL INVESTMENTS IN EXISTING PROGRAMS 

TO RESPOND TO THE OPIOID EPIDEMIC 

Sec. 201. Increase in funding for regional partnership grants. 

Sec. 202. Account for the State and Tribal Response to the Opioid Abuse Crisis. 

TITLE III—EXPANDING ACCESS TO TREATMENT SERVICES 

Sec. 301. Eliminating time limitation for nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse 

midwives, and physician assistants To be qualifying practitioners. 

Sec. 302. Coverage of methadone under Medicare part B. 

3 TITLE I—OPIOID EPIDEMIC 

4 RESPONSE FUND 

5 SEC. 101. OPIOID EPIDEMIC RESPONSE FUND. 

6 (a) IN GENERAL.—The Secretary of Health and 

7 Human Services (referred to in this section as the ‘‘Sec8 retary’’) shall use any funds appropriated pursuant to the 

9 authorization of appropriations under subsection (c) to 

10 carry out the programs and activities described in sub11 section (d) to address the opioid and substance use epi12 demic. Such funds shall be in addition to any funds which 


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1 are otherwise available to carry out such programs and 

2 activities. 

3 (b) OPIOID EPIDEMIC RESPONSE FUND.— 

4 (1) ESTABLISHMENT OF ACCOUNT.—There is 

5 established in the Treasury an account, to be known 

6 as the Opioid Epidemic Response Fund (referred to 

7 in this section as the ‘‘Fund’’), for purposes of fund8 ing the programs and activities described in sub9 section (d). 

10 (2) TRANSFER.—For each of fiscal years 2020 

11 through 2024, $5,000,000,000 shall be transferred 

12 to the Fund from the general fund of the Treasury. 

13 (3) AMOUNTS DEPOSITED.—Any amounts 

14 transferred under paragraph (2) shall remain un15 available in the Fund until such amounts are appro16 priated pursuant to subsection (c). 

17 (c) APPROPRIATIONS.— 

18 (1) AUTHORIZATION OF APPROPRIATIONS.—For 

19 the period of fiscal years 2020 through 2024, there 

20 is authorized to be appropriated from the Fund to 

21 the Department of Health and Human Services, for 

22 the purpose of carrying out the programs and activi23 ties described in subsection (d), an amount not to 

24 exceed the total amount transferred to the Fund 


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1 under subsection (b)(2), to remain available until ex2 pended. 

3 (2) OFFSETTING FUTURE APPROPRIATIONS.— 

4 For any of fiscal years 2020 through 2024, for any 

5 discretionary appropriation to the Department of 

6 Health and Human Services (or any agency therein) 

7 pursuant to the authorization of appropriations 

8 under paragraph (1) for the purpose of carrying out 

9 the programs and activities described in subsection 

10 (d), the total amount of such appropriations for the 

11 applicable fiscal year (not to exceed the total amount 

12 remaining in the Account) shall be subtracted from 

13 the estimate of discretionary budget authority and 

14 the resulting outlays for any estimate under the 

15 Congressional Budget and Impoundment Control 

16 Act of 1974 or the Balanced Budget and Emergency 

17 Deficit Control Act of 1985, and the amount trans18 ferred to the Fund shall be reduced by the same 

19 amount. 

20 (d) PROGRAMS AND ACTIVITIES.—Of the total 

21 amount authorized to be appropriated from the Fund to 

22 the Department of Health and Human Services by sub23 section (c)(1), such amount shall be allocated as follows: 

24 (1) SAMHSA.—For the Substance Abuse and 

25 Mental Health Services Administration to carry out 


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1 programs and activities pursuant to section 102, 

2 $3,650,000,000 for each of fiscal years 2020 

3 through 2024. 

4 (2) CDC.—For the Centers for Disease Control 

5 and Prevention to carry out programs and activities 

6 pursuant to section 103, $500,000,000 for each of 

7 fiscal years 2020 through 2024. 

8 (3) FDA.—For the Food and Drug Adminis9 tration to carry out programs and activities pursu10 ant to section 104, $65,000,000 for each of fiscal 

11 years 2020 through 2024. 

12 (4) NIH.—For the National Institutes of 

13 Health to carry out programs and activities pursu14 ant to section 105, $500,000,000 for each of fiscal 

15 years 2020 through 2024. 

16 (5) HRSA.—For the Health Resources and 

17 Services Administration to carry out programs and 

18 activities pursuant to section 106, $235,000,000 for 

19 each of fiscal years 2020 through 2024. 

20 (6) ACF.—For the Administration for Children 

21 and Families to carry out programs and activities 

22 pursuant to section 107, $50,000,000 for each of 

23 fiscal years 2020 through 2024. 

24 (e) ACCOUNTABILITY AND OVERSIGHT.— 

25 (1) WORK PLAN.— 


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1 (A) IN GENERAL.—Not later than 180 

2 days after the date of enactment of this Act, 

3 the Secretary of Health and Human Services 

4 shall submit to the Committee on Health, Edu5 cation, Labor, and Pensions and the Committee 

6 on Appropriations of the Senate and the Com7 mittee on Energy and Commerce and the Com8 mittee on Appropriations of the House of Rep9 resentatives, a work plan including the proposed 

10 allocation of funds appropriated pursuant to the 

11 authorization of appropriations under subsec12 tion (c) for each of fiscal years 2020 through 

13 2024 and the contents described in subpara14 graph (B). 

15 (B) CONTENTS.—The work plan submitted 

16 under subparagraph (A) shall include— 

17 (i) the amount of money to be obli18 gated or expended out of the Fund in each 

19 fiscal year for each program and activity 

20 described in subsection (d); and 

21 (ii) a description and justification of 

22 each such program and activity. 

23 (2) REPORTS.— 

24 (A) ANNUAL REPORTS.—Not later than 

25 October 1 of each of fiscal years 2020 through 


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1 2024, the Secretary of Health and Human 

2 Services shall submit to the Committee on 

3 Health, Education, Labor, and Pensions and 

4 the Committee on Appropriations of the Senate 

5 and the Committee on Energy and Commerce 

6 and the Committee on Appropriations of the 

7 House of Representatives, a report including— 

8 (i) the amount of money obligated or 

9 expended out of the Fund in the prior fis10 cal year for each program and activity de11 scribed in subsection (d); 

12 (ii) a description of all programs and 

13 activities using funds provided pursuant to 

14 the authorization of appropriations under 

15 subsection (c); and 

16 (iii) how the programs and activities 

17 are responding to the opioid epidemic. 

18 (B) ADDITIONAL REPORTS.—At the re19 quest of the Committee on Health, Education, 

20 Labor, and Pensions or the Committee on Ap21 propriations of the Senate, or the Committee on 

22 Energy and Commerce or the Committee on 

23 Appropriations of the House of Representatives, 

24 the Secretary of Health and Human Services 

25 shall provide an update in the form of testiVerDate Sep 11 2014 02:11 Jun 07, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2922.IH H2922

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1 mony and any additional reports to the respec2 tive congressional committee regarding the allo3 cation of funding under this section or the de4 scription of the programs and activities under5 taken with such funding. 

6 (f) LIMITATIONS.—Notwithstanding any transfer au7 thority authorized by this Act or any appropriations Act, 

8 any funds made available pursuant to the authorization 

9 of appropriations under subsection (c) may not be used 

10 for any purpose other than the programs and activities 

11 described in subsection (d) to address the opioid and sub12 stance use epidemic. 

13 (g) SUNSET.—This section shall expire at the end of 

14 fiscal year 2029. 

15 SEC. 102. SUBSTANCE ABUSE AND MENTAL HEALTH SERV16 ICES ADMINISTRATION. 

17 The entirety of the funds made available pursuant to 

18 section 101(d)(1) shall be for carrying out subsections (b) 

19 and (c) of section 1003 of the 21st Century Cures Act 

20 (42 U.S.C. 290ee–3 note). 

21 SEC. 103. CENTERS FOR DISEASE CONTROL AND PREVEN22 TION. 

23 (a) ADDRESSING OPIOID USE DISORDER.—The en24 tirety of the funds made available pursuant to section 

25 101(d)(2) shall be for the Director of the Centers for DisVerDate Sep 11 2014 02:11 Jun 07, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2922.IH H2922

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1 ease Control and Prevention, pursuant to applicable au2 thorities in the Public Health Service Act (42 U.S.C. 201 

3 et seq.), to continue and expand programs of the Centers 

4 for Disease Control and Prevention to address opioid use 

5 disorder, including by— 

6 (1) improving the timeliness and quality of data 

7 on the opioid epidemic, including improvement of— 

8 (A) data on fatal and nonfatal overdoses; 

9 (B) syndromic surveillance; 

10 (C) data on long-term sequelae (including 

11 neonatal abstinence syndrome); and 

12 (D) cause of death reporting related to 

13 substance abuse or opioid overdose; 

14 (2) expanding and strengthening evidence-based 

15 prevention and education strategies; 

16 (3) supporting responsible prescribing practices, 

17 including through development and dissemination of 

18 prescriber guidelines; 

19 (4) improving access to and use of effective pre20 vention, treatment, and recovery support, including 

21 through grants and the provision of technical assist22 ance to States and localities; 

23 (5) strengthening partnerships with first re24 sponders, including to protect their safety; 


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1 (6) considering the needs of vulnerable popu2 lations; 

3 (7) addressing infectious diseases linked to the 

4 opioid crisis; 

5 (8) strengthening prescription drug monitoring 

6 programs; and 

7 (9) providing financial and technical assistance 

8 to State and local health department efforts to treat 

9 and prevent substance use disorder. 

10 (b) LIMITATION.—Of the funds made available pur11 suant to section 101(d)(2) for carrying out this section, 

12 not more than 20 percent may be used for intramural pur13 poses. 

14 SEC. 104. FOOD AND DRUG ADMINISTRATION. 

15 The entirety of the funds made available pursuant to 

16 section 101(d)(3) shall be for the Commissioner of Food 

17 and Drugs, pursuant to applicable authorities in the Pub18 lic Health Service Act (42 U.S.C. 201 et seq.) or the Fed19 eral Food, Drug, and Cosmetic Act (21 U.S.C. 301 et 

20 seq.) and other applicable law, to support widespread inno21 vation in non-opioid and non-addictive medical products 

22 for pain treatment, access to opioid addiction treatments, 

23 appropriate use of approved opioids, and efforts to reduce 

24 illicit importation of opioids. Such support may include the 

25 following: 


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1 (1) Facilitating the development of non-opioid 

2 and non-addictive pain treatments. 

3 (2) Advancing guidance documents for sponsors 

4 of non-opioid pain products. 

5 (3) Developing evidence to inform the potential 

6 for nonprescription overdose therapies. 

7 (4) Examining expanded labeling indications for 

8 medication-assisted treatment. 

9 (5) Conducting public education and outreach, 

10 including public workshops or public meetings, re11 garding the benefits of medication-assisted treat12 ment, and approved non-opioid drug and device 

13 treatment options. 

14 (6) Exploring the expansion and possible man15 datory nature of prescriber education regarding pain 

16 management and appropriate opioid prescribing 

17 through authorities under section 505–1 of the Fed18 eral Food, Drug, and Cosmetic Act (21 U.S.C. 355– 

19 1). 

20 (7) Examining options to limit the duration of 

21 opioid prescriptions for acute pain, including 

22 through packaging options. 

23 (8) Increasing staff and infrastructure capacity 

24 to inspect and analyze packages at international 

25 mail facilities and pursue criminal investigations. 


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1 SEC. 105. NATIONAL INSTITUTES OF HEALTH. 

2 The entirety of the funds made available pursuant to 

3 section 101(d)(4) shall be for the Director of the National 

4 Institutes of Health, pursuant to applicable authorities in 

5 the Public Health Service Act (42 U.S.C. 201 et seq.), 

6 to carry out activities related to— 

7 (1) accelerating research for addressing the 

8 opioid epidemic, including developing non-opioid 

9 medications and interventions, including non-addict10 ive medications, to manage pain, as well as to treat 

11 and to prevent substance use disorders; 

12 (2) conducting and supporting research on 

13 which treatments (in terms of pain management as 

14 well as treating and preventing substance use dis15 orders) are optimal for which patients; and 

16 (3) conducting and supporting research on cre17 ating longer-lasting or faster-acting antidotes for 

18 opioid overdose, particularly in response to the prev19 alence of fentanyl and carfentanyl overdoses. 

20 SEC. 106. HEALTH RESOURCES AND SERVICES ADMINIS21 TRATION. 

22 The entirety of the funds made available pursuant to 

23 section 101(d)(5) shall be for the Administrator of the 

24 Health Resources and Services Administration, pursuant 

25 to applicable authorities in titles III, VII, and VIII of the 

26 Public Health Service Act (42 U.S.C. 241 et seq.), to 


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1 carry out activities that increase the availability and ca2 pacity of the behavioral health workforce. Such activities 

3 may include providing loan repayment assistance for sub4 stance abuse treatment providers. 

5 SEC. 107. ADMINISTRATION FOR CHILDREN AND FAMILIES. 

6 Of the funds made available pursuant to section 

7 101(d)(6) for each of fiscal years 2020 through 2024— 

8 (1) $25,000,000 for each such fiscal year shall 

9 be for the Secretary of Health and Human Services 

10 to carry out title I of the Child Abuse Prevention 

11 and Treatment Act (42 U.S.C. 5101 et seq.); and 

12 (2) $25,000,000 for each such fiscal year shall 

13 be for the Secretary of Health and Human Services 

14 to carry out title II of such Act (42 U.S.C. 5116 et 

15 seq.). 

16 TITLE II—ADDITIONAL INVEST17 MENTS IN EXISTING PRO18 GRAMS TO RESPOND TO THE 

19 OPIOID EPIDEMIC 

20 SEC. 201. INCREASE IN FUNDING FOR REGIONAL PARTNER21 SHIP GRANTS. 

22 Section 436 of the Social Security Act (42 U.S.C. 

23 629f) is amended— 

24 (1) in subsection (a), by striking 

25 ‘‘$345,000,000 for each of fiscal years 2017 through 


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1 2021’’ and inserting ‘‘$385,000,000 for each of fis2 cal years 2018 through 2024’’; and 

3 (2) in subsection (b)— 

4 (A) in paragraph (4)(A), by striking ‘‘2017 

5 through 2021’’ and inserting ‘‘2018 through 

6 2024’’; and 

7 (B) in paragraph (5), by striking 

8 ‘‘$20,000,000 for each of fiscal years 2017 

9 through 2021’’ and inserting ‘‘$60,000,000 for 

10 each of fiscal years 2018 through 2024’’. 

11 SEC. 202. ACCOUNT FOR THE STATE AND TRIBAL RE12 SPONSE TO THE OPIOID ABUSE CRISIS. 

13 Section 1003(h) of the 21st Century Cures Act (42 

14 U.S.C. 290ee–3 note) is amended by striking 

15 ‘‘$500,000,000 for each of fiscal years 2019 through 

16 2021’’ and inserting ‘‘$500,000,000 for fiscal years 2019 

17 and $3,750,000,000 for each of fiscal years 2020 through 

18 2023’’. 


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1 TITLE III—EXPANDING ACCESS 

2 TO TREATMENT SERVICES 

3 SEC. 301. ELIMINATING TIME LIMITATION FOR NURSE 

4 PRACTITIONERS, CLINICAL NURSE SPECIAL5 ISTS, CERTIFIED REGISTERED NURSE ANES6 THETISTS, CERTIFIED NURSE MIDWIVES, AND 

7 PHYSICIAN ASSISTANTS TO BE QUALIFYING 

8 PRACTITIONERS. 

9 Section 303(g)(2)(G)(iii)(III) of the Controlled Sub10 stances Act (21 U.S.C. 823(g)(2)(G)(iii)(III)) is amended 

11 by striking ‘‘for the period beginning on October 1, 2018, 

12 and ending on October 1, 2023,’’. 

13 SEC. 302. COVERAGE OF METHADONE UNDER MEDICARE 

14 PART B. 

15 (a) COVERAGE.—Section 1861(s)(2) of the Social Se16 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

17 (1) by striking ‘‘and’’ at the end of subpara18 graph (GG); 

19 (2) by adding ‘‘and’’ at the end of subpara20 graph (HH); and 

21 (3) by inserting after subparagraph (HH) the 

22 following new subparagraph: 

23 ‘‘(II) methadone, if furnished or dispensed 

24 (including by prescription) in an oral form on 

25 or after January 1, 2019, to an individual for 


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1 the purpose of maintenance or detoxification 

2 treatment by a physician or other practitioner 

3 who has in effect a registration or waiver under 

4 section 303(g) of such Act (21 U.S.C. 823(g)) 

5 to dispense methadone for such purpose;’’. 

6 (b) PAYMENT.— 

7 (1) IN CONNECTION WITH PHYSICIAN AND SUP8 PLIER SERVICE.—Section 1842(o)(1) of the Social 

9 Security Act (42 U.S.C. 1395u(o)(1)) is amended by 

10 adding at the end the following new subparagraph: 

11 ‘‘(H) In the case of methadone (as de12 scribed in section 1861(s)(2)(II)), the amount 

13 provided under section 1847A for such drug.’’. 

14 (2) COVERED OPD SERVICE.—Section 

15 1833(t)(1)(B)(iii) of the Social Security Act (42 

16 U.S.C. 1395l(t)(1)(B)(iii)) is amended by inserting 

17 ‘‘and methadone described in paragraph (2)(II) of 

18 such section’’ after ‘‘section 1861(s)’’. 

19 (c) BUDGET NEUTRALITY.—The Secretary of Health 

20 and Human Services shall implement the amendments 

21 made by this section in a manner such that— 

22 (1) estimated expenditures under the physician 

23 fee schedule under section 1848 of the Social Secu24 rity Act (42 U.S.C. 1395w–4) with application of 

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1 tures under such schedule without application of 

2 such amendments; and 

3 (2) estimated expenditures under the prospec4 tive payment system under section 1833(t) of the 

5 Social Security Act (42 U.S.C. 1395l(t)) with appli6 cation of such amendments made by this section are 

7 equal to estimated expenditures under such system 

8 without application of such amendments. 

Æ 


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